Techniques & Technologies

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Electroconvulsive therapy (ECT)

"Ectonustim 3" electroconvulsive therapy (ECT) machine, with headset, by Ectron Ltd, England, 1958-1965. Ectonustim 3' electroconvulsive therapy (ECT) machine, with scalp electrodes, by Ectron Ltd, England, 1958-1965. ECT involves the transmission of an electrical current to the brain in timed pulses, causing a convulsion or seizure. The intention being to 'shock' a patient out of a severe mental disorder. It is a controversial therapy but one that is still sometimes used, mainly in the treatment of severe depression.

Electroconvulsive therapy (ECT), sometimes called ‘electroshock’, was one of the most controversial psychiatric treatments of the 20th century. It began in the 1930s, at a time when some psychiatrists in Europe and the US experimented with the drug metrazol to induce epileptic-like convulsions in schizophrenic patients. The theory was that epilepsy and schizophrenia were opposed. However, the convulsions were so violent that many patients broke bones or fractured their spines. Italian neurologist and epilepsy specialist Ugo Cerletti wanted to produce similar effects in a more controlled way. He adapted electric shock techniques used to stun animals, and created ECT.

ECT applied brief but powerful shocks via two electrodes, called ‘paddles’, placed on the patient’s forehead. The technique became widespread in mental hospitals across Europe and North America as it was less dangerous than drug-induced convulsions or comas. Doctors tried it on a wider range of patients. ECT treated severe depression as well as schizophrenia.

Electronics technology advanced during the Second World War, and ECT machines became safer and more controllable. However, it remained an aggressive treatment. Mouth guards, bodily restraints and anaesthetic drugs protected patients from being hurt. One unexpected side effect of ECT was memory loss. This included forgetting what happened in the treatment room, which raised troubling questions about informed consent.

An increasing number of ex-patients and psychiatrists criticised ECT from the 1960s onwards. The antipsychiatry movement thought it a brutal way to control mental patients deemed ‘troublesome’. Psychiatric drugs became available in the 1960s and 1970s to treat schizophrenia and depression, and ECT became less popular. Evidence accumulated that it caused long-term memory loss. Today, ECT treats a small number of cases of severe depression which do not respond to psychiatric drugs. With rare exceptions, it is only used at the patient’s request.